Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $335.54 / $2,974.00 / $6,904.50	Facility		$335.54	$2,974.00	$6,904.50
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $166.86 / $268.54 / $450.19	Facility	52	$166.86	$268.54	$450.19
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $80.84 / $166.99 / $320.18	Facility	53	$80.84	$166.99	$320.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $193.28 / $364.21 / $929.79	Professional		$193.28	$364.21	$929.79
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $50.26 / $108.70 / $271.61	Professional	53	$50.26	$108.70	$271.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $177.57 / $307.98 / $361.88	Professional		$177.57	$307.98	$361.88
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $71.26 / $146.97 / $239.21	Professional	53	$71.26	$146.97	$239.21
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $573.65 / $2,532.58 / $16,394.00	Facility		$573.65	$2,532.58	$16,394.00
Asuris Northwest Health Facility/Professional Facility Modifier 52 Low / Median / High Price $373.28 / $663.66 / $663.66	Facility	52	$373.28	$663.66	$663.66
Asuris Northwest Health Facility/Professional Facility Modifier 53 Low / Median / High Price $93.32 / $165.92 / $165.92	Facility	53	$93.32	$165.92	$165.92
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $304.56 / $669.89 / $2,761.67	Professional		$304.56	$669.89	$2,761.67
Asuris Northwest Health Facility/Professional Professional Modifier 53 Low / Median / High Price $144.44 / $256.18 / $430.61	Professional	53	$144.44	$256.18	$430.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $625.25 / $761.81 / $1,159.36	Facility		$625.25	$761.81	$1,159.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $244.69 / $474.44 / $955.47	Professional		$244.69	$474.44	$955.47
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $116.81 / $210.90 / $298.33	Professional	53	$116.81	$210.90	$298.33
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $276.06 / $519.22 / $1,016.72	Facility		$276.06	$519.22	$1,016.72
Kaiser Permanente Facility/Professional Facility Modifier 53 Low / Median / High Price $91.68 / $196.47 / $374.85	Facility	53	$91.68	$196.47	$374.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.22 / $490.62 / $904.55	Professional		$263.22	$490.62	$904.55
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $91.68 / $196.47 / $366.02	Professional	53	$91.68	$196.47	$366.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $66.38 / $354.59 / $722.70	Professional		$66.38	$354.59	$722.70
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $378.68 / $662.38 / $722.46	Facility		$378.68	$662.38	$722.46
Pacific Source Facility/Professional Facility Modifier 53 Low / Median / High Price $278.58 / $364.48 / $695.64	Facility	53	$278.58	$364.48	$695.64
Pacific Source Facility/Professional Professional Modifier 53 Low / Median / High Price $248.06 / $377.58 / $693.00	Professional	53	$248.06	$377.58	$693.00
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $422.54 / $467.50 / $671.06	Facility		$422.54	$467.50	$671.06
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $304.56 / $493.60 / $881.64	Professional		$304.56	$493.60	$881.64
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,889.92 / $2,590.05 / $4,954.47	Facility		$1,889.92	$2,590.05	$4,954.47
Regence BlueShield Facility/Professional Facility Modifier 53 Low / Median / High Price $1,539.68 / $1,539.68 / $2,392.77	Facility	53	$1,539.68	$1,539.68	$2,392.77
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $313.02 / $513.54 / $788.71	Professional		$313.02	$513.54	$788.71
Regence BlueShield Facility/Professional Professional Modifier 53 Low / Median / High Price $145.93 / $252.57 / $386.59	Professional	53	$145.93	$252.57	$386.59
United Facility/Professional Facility Modifier Low / Median / High Price $650.00 / $1,120.00 / $6,857.00	Facility		$650.00	$1,120.00	$6,857.00
United Facility/Professional Professional Modifier Low / Median / High Price $360.88 / $565.19 / $983.84	Professional		$360.88	$565.19	$983.84
United Facility/Professional Professional Modifier 53 Low / Median / High Price $165.30 / $361.63 / $422.53	Professional	53	$165.30	$361.63	$422.53
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $192.49 / $279.66 / $375.99	Professional		$192.49	$279.66	$375.99
Wellpoint Facility/Professional Professional Modifier 53 Low / Median / High Price $96.58 / $139.97 / $188.13	Professional	53	$96.58	$139.97	$188.13